A SUMMARY OF SMOKING CESSATION: A REPORT OF THE SURGEON GENERAL – 2020

Smoking Cessation – 

The Role of Healthcare Professionals and Health Systems 

Smoking in the U.S.

Since the first Surgeon General’s report on smoking and health was 

released in 1964, cigarette smoking among U.S. adults has declined from 

nearly 43% to a low of nearly 14% in 2018. Despite this progress, smoking 

remains the leading cause of preventable disease and death in the U.S. 

Additionally, smoking-related illnesses continue to cost the nation more 

than $300 billion every year. 

Smoking Cessation Saves Lives 

and Money

Tobacco dependence is a chronic, relapsing condition driven by 

addiction to nicotine. But cessation treatment can help people quit. 

The 2020 Surgeon General’s Report highlights the latest evidence on the 

benefits of smoking cessation. The evidence is clear – one of the most 

important actions people can take to improve their health is to quit 

smoking, no matter how old they are or how long they’ve been smoking. 

Smoking cessation:

Reduces the risk of premature death, improves health, and 

enhances quality of life. Quitting can add as much as a decade to 

life expectancy.

Reduces the risk for many adverse health effects, including poor 

reproductive health outcomes, cardiovascular diseases, chronic 

obstructive pulmonary disease (COPD), and 12 types of cancer. 

Benefits people already diagnosed with coronary heart disease or COPD.

Benefits the health of pregnant women and that of their fetuses 

and babies.

Reduces the financial burden that smoking places on people who 

smoke, healthcare systems, and society.

Most Adults Who Smoke 

Want to Quit 

The report highlights the progress made in reducing smoking in 

the U.S.: 

Nearly 70% of adults who smoke say they want to quit.

Over 50% of adults who smoke try to quit each year.

Three in five adults who ever smoked cigarettes have quit.

The report also presents findings that underscore the challenges we face 

to further reduce smoking:

Over 40% of adults who smoke do not receive advice to quit from a 

healthcare professional.

Fewer than one in three adults who smoke use cessation counseling 

or FDA-approved medications when trying to quit.

Fewer than one in 10 U.S. adults successfully quit smoking each year. 

Key Findings from the 2020 

Surgeon General’s Report

Smoking cessation reduces risk for many adverse health 

effects, including poor reproductive health outcomes, 

cardiovascular diseases, chronic obstructive pulmonary 

disease (COPD), and cancer. Quitting smoking is also 

beneficial to those who have been diagnosed with heart 

disease and COPD.

More than three out of five U.S. adults who have ever 

smoked cigarettes have quit. Although a majority of 

cigarette smokers make a quit attempt each year, less 

than one-third use cessation medications approved 

by the U.S. Food and Drug Administration (FDA) or 

behavioral counseling to support quit attempts. 

Considerable disparities exist in the prevalence of 

smoking across the U.S. population, with higher 

prevalence in some subgroups. Similarly, the prevalence 

of key indicators of smoking cessation—quit attempts, 

receiving advice to quit from a health professional, 

and using cessation therapies—also varies across the 

population, with lower prevalence in some subgroups. 

Smoking cessation medications approved by the FDA 

and behavioral counseling are cost-effective cessation 

strategies. Cessation medications approved by the 

FDA and behavioral counseling increase the likelihood 

of successfully quitting smoking, particularly when 

used in combination. Using combinations of nicotine 

replacement therapies can further increase the likelihood 

of quitting. 

Insurance coverage for smoking cessation treatment 

that is comprehensive, barrier-free, and widely promoted 

increases the use of these treatment services, leads to 

higher rates of successful quitting, and is cost-effective. 

E-cigarettes, a continually changing and heterogeneous 

group of products, are used in a variety of ways. 

Consequently, it is difficult to make generalizations 

about efficacy for cessation based on clinical trials 

involving a particular e-cigarette, and there is presently 

inadequate evidence to conclude that e-cigarettes, in 

general, increase smoking cessation. 

For information about:

quitting smoking, visit www.CDC.gov/quit

the Surgeon General’s report, visit

www.CDC.gov/CessationSGR
Evidence-Based Cessation 

Treatments Work

Tobacco use and dependence often requires repeated intervention and 

long-term support to help patients quit. The report outlines an array of 

effective treatments and resources, including:

` Counseling and medication – Each is effective when used

alone, and using them together can more than double the chances

of quitting.

` Combining medications – Compared to using a single form of

nicotine replacement therapy (NRT), combining long-acting NRT

(e.g., patch) with a short-acting NRT (e.g., lozenge) increases the 

chances of quitting.

` Tobacco quitlines – Proactive counseling from quitlines 

increases the chances of quitting when used alone or together 

with cessation medication. Text messaging and web-based cessation 

interventions can also help people successfully quit smoking. 

E-Cigarettes and Adult Cessation

Many adults who smoke are interested in using e-cigarettes to quit 

cigarettes. Research is uncertain on whether e-cigarettes, in general, 

increase smoking cessation. Some research suggests that using 

e-cigarettes containing nicotine is associated with greater smoking 

cessation than using e-cigarettes that don’t contain nicotine, and some 

research suggests that more frequent use of e-cigarettes is associated with 

greater smoking cessation than less frequent use. However, e-cigarettes 

are not currently approved by the FDA as a quit smoking aid, and more 

research is needed on whether e-cigarettes are effective for smoking 

cessation and to better understand the health effects of e-cigarettes. 

The use of any tobacco products, including e-cigarettes, is not safe for 

youth, young adults, or pregnant women, as well as adults who do not 

currently use tobacco products. In order for adult smokers to achieve any 

meaningful health benefits from e-cigarettes, they would need to fully 

switch to e-cigarettes and stop smoking cigarettes and other tobacco 

products completely. Among those who have switched completely, the 

ultimate goal should be to also stop using e-cigarettes completely to 

achieve the maximum health benefit. 

You Can Help Your 

Patients Quit

Healthcare professionals can help patients quit by:

• Advising them to quit 

• 

• 

• 

• 

Offering brief counseling 

Prescribing cessation medications

Connecting them to additional resources, like 

a quitline 

Following up with continued support to help 

prevent relapse

Every member of the care team can help. Delegating

these tasks can improve efficiency and support a 

coordinated-care approach.

Providing cessation treatment is reimbursable and can

help meet quality measures.

Health System and 

Population-Level Interventions

The Surgeon General’s Report reviews effective health system and 

population-level interventions that can promote cessation and 

extend the reach and use of clinical treatments. Health systems 

can adopt policies and changes to integrate tobacco dependence 

treatment into routine care and make it easier for healthcare teams to 

deliver treatment (e.g., integrating cessation content into electronic 

health records). Additionally, comprehensive, barrier-free smoking 

cessation insurance coverage that is widely promoted can increase 

the use of evidence-based treatments and cessation. Populationlevel interventions, such as raising the price of cigarettes, adopting 

comprehensive smokefree policies, implementing mass media 

campaigns, requiring pictorial health warnings, and maintaining 

comprehensive statewide tobacco control programs also support and 

increase smoking cessation.

Smoking Cessation Resources 

for Healthcare Professionals

Clinical Practice Guideline for Treating Tobacco Use 

and Dependence – www.ahrq.gov/prevention/guidelines/

tobacco/index.html

CDC’s Office on Smoking and Health – 

www.CDC.gov/tobaccohcp

Million Hearts – millionhearts.hhs.gov/tools-protocols/

tools/tobacco-use.html

Smokefree.gov – www.smokefree.gov